Individual
RAMIRO D. CAVAZOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1108 S HENDERSON ST, FORT WORTH, TX 76104-4430
(817) 335-3255
(817) 338-9563
Mailing address
1108 S HENDERSON ST, FORT WORTH, TX 76104-4430
(817) 335-3255
(817) 338-9563
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
D9388
TX
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
D9388
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10028699
AMERIGROUP
TX
05
—
127096903
—
TX
01
—
130900703
MEDICAID EPSDT
TX
01
—
4229409
AETNA
TX
01
—
83214X
BCBS
TX
Enumeration date
05/01/2006
Last updated
07/17/2008
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